Individual
DR. JEREMY ELLIOTT KASLOW
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
720 N TUSTIN AVE STE 202, SANTA ANA, CA 92705-3606
(714) 565-1032
(714) 565-1035
Mailing address
720 N TUSTIN AVE STE 202, SANTA ANA, CA 92705-3606
(714) 565-1032
(714) 565-1035
Taxonomy
Speciality
Code
Description
License number
State
207KI0005X
Clinical & Laboratory Immunology (Allergy & Immunology) Physician
G55911
CA
207RA0201X
Allergy & Immunology (Internal Medicine) Physician
Primary
G55911
CA
2080P0201X
Pediatric Allergy/Immunology Physician
G55911
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
33-0428376
FEIN
CA
01
—
82-0877333
FEIN
CA
01
—
G55911
CALIFORNIA STATE LICENSE
CA
Enumeration date
10/25/2006
Last updated
08/06/2024
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